CENTER FOR HEALTH INFORMATION AND ANALYSIS
MASSACHUSETTS ACUTE HOSPITAL AND HEALTH SYSTEM FINANCIAL PERFORMANCE: FY 2018 SEPTEMBER 2019
CHIA
Table of Contents
Introduction...... 1 FY 2018 Average Payment Period by Health System...... 13 FY 2018 Total Margin for Systems with Multiple Acute Hospitals by Component Entity...... 4 FY 2014-FY 2018 Current Ratio and Average Payment Period Trends...... 14 FY 2018 Total Margin for Independent Health Systems by Component Entity...... 5 FY 2018 Equity Financing Ratio by Health System...... 15
FY 2018 Operating Margin for Systems with Multiple Acute FY 2014-FY 2018 Equity Financing Ratio Trends ...... 16 Hospitals by Component Entity ...... 6 FY 2018 Acute Hospital Total Margin by Region...... 17 FY 2018 Operating Margin for Independent Health Systems by Component Entity...... 7 FY 2018 Health System, Hospital, Physician Organization, and Health Plan Metrics ...... 18 FY 2014-FY 2018 Total and Operating Margin Trends by Hospital Cohort ...... 8 Report Notes...... 23
FY 2018 Hospital-Affiliated Physician Organization Acute Hospital Cohort Definitions...... 24 Total Margin...... 9 Regional Definitions...... 25 FY 2014-FY 2018 HHS-Afilliated Health Plan Total Margin...... 10
FY 2018 Current Ratio for Systems with Multiple Acute Hospitals ...... 11
FY 2018 Current Ratio for Independent Health Systems...... 12
i Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA
Introduction
The Center for Health Information and Analysis (CHIA) reports on the annual and quarterly financial performance of acute hospitals. As the financial performance of hospital health systems is important to understanding the greater contexts in which hospitals operate, CHIA has expanded its reporting to include the financial performance of hospital health systems (HHS), affiliated physician organizations (PO), and related health plans.
In fiscal year (FY) 2018, Massachusetts had 27 hospital health systems, which included 61 acute hospitals, 51 physician organizations, and three health plans. Hospitals are grouped into four primary cohorts based on similar characteristics: Academic Medical Centers (AMCs), teaching hospitals, community hospitals, and community-High Public Payer (HPP) hospitals. Specialty hospitals are not considered a cohort due to the unique patient population served and/or the unique sets of services provided. Specialty hospitals are included in statewide medians but are not included in the cohort analyses. This report assigns hospitals to cohorts based on FY 2018 data.
Twelve out of 27 hospital health systems operate more than one acute hospital and are classified as multi-acute systems. The remaining 15 operate one acute hospital and are classified as independent systems. Four systems (Steward Health Care, Tenet Healthcare, Trinity Health, and Shriners Hospitals for Children) are part of larger systems that operate hospitals nationwide.
Hospital health systems consist of all consolidated health entities, including acute hospitals, non-acute hospitals, physician organizations, and health plans. They may also include consolidated non-health care entities, such as foundations and real estate trusts.
1 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Steward Health Care did not submit the required system level audited financial statement data. Steward Health Care system level data included in this report was obtained from a publicly available data source.
This report contains 12 months of fiscal year end data for FY 2018 for all systems and hospitals based on each hospital’s year end date. Most hospitals’ fiscal year end is September 30, with the exception of Steward Health Care, Trinity Health, Cambridge Health Alliance, Tenet Healthcare, and Shriners Hospitals for Children.
This publication reports on the profitability, liquidity, and solvency of hospital health systems and their affiliated acute hospitals, physician organizations, and health plans.
2 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA KEY FINDINGS 19 47
Of the 27 hospital Of the 61 acute health systems,19 hospitals,47 reported a surplus. reported a surplus.
1.6 4.5%
The statewide median The statewide median acute Of the 49 physician organizations acute hospital hospital total margin was 4.5%, that reported data, five current ratio was 1.6. a 1.3 percentage point reported a surplus. increase from FY 2017.
2.7% 56
Acute hospitals tended to have The statewide median acute Of the 61 acute hospitals greater margins than their hospital operating margin was that reported data, 56 associated parent systems. 2.7%, a 1.1 percentage point had positive net assets. increase from FY 2017.
3 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA FY 2018 Total Margin for Systems with Multiple Acute Hospitals PROFITABILITY by Component Entity
Total margin reflects the excess of total revenues over total expenses— aystate ealth including operating and non- operating activities—as a percentage of total revenue. er shire ealth ystems Seven of the 11 multi-acute health systems were profitable. The a e od ealthcare multi-acute health system that reported the lowest total margin are ro was Steward Health Care at -4.1%, while the system that reported the highest total margin was Cape Cod ey ood ealthcare Healthcare at 7.2%.
The acute care hospital that reported ahey ealth ystem the lowest total margin was Steward Carney Hospital (part of Steward Health Care) at -19.7%, while the artners ealth are acute care hospital that reported the highest total margin was Saint te ard ealth are Vincent Hospital (part of Tenet Healthcare) at 14.6%. enet ealthcare Most of the physician organizations associated with a multi-acute health system reported a loss, with the ass emorial ealth are exception of three from Partners Healthcare (Massachusetts General Hospital Physicians Organization; ellforce Brigham and Women’s Physicians
Organizations; and Massachusetts ≈
Eye and Ear Associates) and two cademic omm nity omm nity i h ealth ealth hysician ecialty eachin from CareGroup (Harvard Medical edical enter os ital lic ayer lan ystem r ani ation os ital os ital Faculty Physicians and New England Baptist Physician Group). Health New England and Notes: Shriners Hospitals for Children are not included in the analysis or graph due to reporting differences. Twenty physician organizations are outliers with margins < -20%. Detailed Neighborhood Health Plan information is provided in the accompanying databook. For complete definitions of acute hospital types, please see page 24. reported positive total margins.
4 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA FY 2018 Total Margin for Independent Health Systems PROFITABILITY by Component Entity
Twelve of the 15 independent ital health systems reported oston hildren s os ital and sidiariesaries positive total margins. The total nter oston edical enter ealth ystem margins for independent health stem systems ranged from -1.8% am rid e ealth llianceance for Lawrence General Hospital ana ar er ancer nstit te and sidiariesncer and Affiliates to 16.7% for aries Boston Children’s Hospital and stem merson ealth ystem and sidiariesaries Subsidiaries. are arrin ton ealth are ystemstem Associated acute care hospital ital performance ranged from Lawrence General Hospital and Affiliatesiates
-4.2% for Mercy Medical dical Milford Regional Medical Center and Affiliatesiates Center (part of Trinity Health) alth to 11.5% for Sturdy Memorial eacoast e ional ealth ystemstem Hospital (part of Sturdy i nat re ealthcare or orationcare Memorial Foundation and tion Affiliates). Two of the 15 o th hore ealth ystemstem associated acute care hospitals o thcoast ealth ystemstems reported negative total margins. orial Only Physicians Organization Sturdy Memorial Foundation and Affiliatesiates at Children’s Hospital and rinity ealthalth Foundation reported a positive total margin at 13.6%. The alley ealth ystemstem other 17 independent health system associated physician ≈ organizations reported negative cademic omm nity omm nity i h ealth ealth hysician ecialty eachin edical enter os ital lic ayer lan ystem r ani ation os ital os ital total margins. BMC Health Plan reported a positive total margin at 0.2%.
Notes: Eight physician organizations are outliers with total margins < -20%. Detailed information is provided in the accompanying databook.
5 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA FY 2018 Operating Margin for Systems with Multiple Acute Hospitals PROFITABILITY by Component Entity
Operating margin reflects the excess of operating revenues aystate ealth over operating expenses, including patient care and other er shire ealth ystems activities, as a percentage of operating revenue. a e od ealthcare Seven of the 11 multi-acute systems reported a positive operating margin. Operating are ro margins ranged from -4.2% for Steward Health Care to ey ood ealthcare 2.2% for Partners HealthCare, Baystate Health, and Cape Cod Healthcare. ahey ealth ystem Associated acute hospital performance varied, with artners ealth are Steward Carney Hospital (part of Steward Health Care) te ard ealth are reporting a -21.6% operating margin and Saint Vincent Hospital (part of Tenet enet ealthcare Healthcare) reporting a 14.6% operating margin. ass emorial ealth are Four of 32 associated physician organizations reported a positive ellforce operating margin. Neighborhood Health Plan and ≈ Health New England reported cademic omm nity omm nity i h ealth ealth hysician ecialty eachin positive operating margins of edical enter os ital lic ayer lan ystem r ani ation os ital os ital 2.6% and 1.6%, respectively.
Notes: Shriners Hospitals for Children are not included in the analysis or graph due to reporting differences. Twenty physician organizations and one teaching hospital are outliers with operating margins < -20%. Detailed information is provided in the accompanying databook.
6 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA FY 2018 Operating Margin for Independent Health Systems PROFITABILITY by Component Entity
Nine of the 15 independent acute s os ital oston hildren s os ital and sidiaries hospital health systems reported sidiaries positive operating margins. ical enter oston edical enter ealth ystemlth ystem Operating margins for the health systems ranged from -3.2% for am rid e ealth lliancelth lliance Dana-Farber Cancer Institute ana ar er ancer nstit te and sidiariesr er ancer and Subsidiaries to 2.3% for sidiaries Boston Children’s Hospitals and lth ystem merson ealth ystem and sidiaries sidiaries Subsidiaries. arrin ton ealth are ystemealth are Associated acute hospital ystem performance ranged from an ral os ital Lawrence General Hospital and Affiliatesd ffi liates operating margin of -4.2% for nal edical Mercy Medical Center (part Milford Regional Medical Center and Affiliatesd ffi liates of Trinity Health) to 5.9% for eacoast e ional ealth o ystemnal ealth Southcoast Hospitals Group ystem (Southcoast Health Systems). ealthcare i nat re ealthcare or orationor oration Only Physicians Organization o th hore ealth ystemlth ystem at Children’s Hospital and
Foundation reported a positive o thcoast ealth ystemslth ystems operating margin at 4.9%, y emorial whereas the other 17 associated Sturdy Memorial Foundation and Affiliatesd ffi liates physician organizations reported rinityn ealthity ealth negative operating margins. BMC Health Plan reported a alley ealth ystemlth ystem negative operating margin at -0.5%. ≈
cademic omm nity omm nity i h ealth ealth hysician ecialty eachin edical enter os ital lic ayer lan ystem r ani ation os ital os ital
Notes: Eight physician organizations are outliers with operating margins < -20%. Detailed information is provided in the accompanying databook.
7 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA FY 2014-FY 2018 Total and Operating Margin Trends PROFITABILITY by Hospital Cohort
The statewide acute hospital Total Margin Trends Operating Margin Trends median total margin increased 8% 8% by 1.3 percentage points, from 7% 3.2% in 2017 to 4.5% in 2018. 7% Of the four hospital cohorts, 6% 6% the Academic Medical Center, teaching, and community- 5% 5% High Public Payer cohorts saw increases in median total 4% 4% margin, while the community hospital cohort decreased by 3% 3% 0.5 percentage points during the same time period. 2% 2% The statewide acute hospital 1% median operating margin 1% increased by 1.1 percentage 0% points, from 1.6% in 2017 to 0% 2.7% in 2018. All of the cohorts -1% -1% F 2014 F 2015 F 2016 F 2017 F 2018 saw an increase in median F 2014 F 2015 F 2016 F 2017 F 2018 operating margin year over Statewide Acute Academic Medical Center Teaching Hospital Community Hospital Community-High Public Payer Hospital Health System year. The teaching cohort had the most significant increase 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 between 2017 and 2018 (2.1 Statewide Acute Median 4.1% 3.8% 3.1% 3.2% 4.5% Statewide Acute Median 2.4% 3.2% 2.8% 1.6% 2.7% percentage points). Academic Medical Center 4.7% 2.4% 3.0% 2.0% 5.0% Academic Medical Center 2.6% 2.6% 1.9% 1.8% 2.8% The median total and operating Teaching Hospital 8.2% 4.2% 5.7% 2.0% 6.0% Teaching Hospital 5.6% 4.2% 3.8% 2.7% 4.8% margins for hospital health Community Hospital 3.1% 2.4% 1.1% 2.6% 2.1% Community Hospital 1.3% 2.4% 1.5% 0.4% 1.8% systems both increased from Community-High Public Payer 5.0% Community-High Public Payer 3.4% the prior year, increasing by 5.2% 5.2% 4.5% 3.8% 4.6% 5.0% 3.4% 2.9% 0.5 and 0.4 percentage points, Health System 1.6% Health System 0.0% respectively. 2.6% 1.2% 1.2% 1.1% 1.0% 1.0% 0.5% -0.4%
Notes: Steward Health Care’s system level data are not included in 2016-2017 as they did not submit audited or standardized financial statements. The statewide acute hospital median includes specialty hospitals.
8 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA PROFITABILITY FY 2018 Hospital-Affiliated Physician Organization Total Margin
Physician organizations vary hysician Health Net atient MEDIAN -24.6% greatly in terms of size, services Organi ation Name System Service Revenue Mercy npatient Medical Associates Trinity Health $9.6 M provided, and specialty. Similarly, Nantucket Physician Organization Partners $2.7 M Tufts Medical Center Community Care Wellforce $3.8 M total margins, profits, and losses Community Medical Associates Lawrence eneral $2.0 M Pioneer Valley Cardiology Associates Trinity Health $8.0 M also vary. Community Physicians Associates Care roup $3.8 M Lahey Physician Community Organization Lahey Health $14.3 M The reported total margin ranged Mercy Medical roup Trinity Health $8.4 M Northeast Medical Practice Lahey Health $25.6 M from -116% to 14% and the Harrington Physician Services Harrington Healthcare $23.9 M reported net patient service Mercy Specialist Physicians Trinity Health $5.9 M Western Mass Physician Associates Valley Health $7.8 M revenue ranged from $215,000 Berkshire Faculty Services Berkshire Health $39.0 M Baystate Westfield Medical Corporation Baystate Health $10.8 M to $780 million. The reported Saint Vincent Medical Company Tenet Healthcare $29.2 M total revenue ranged from Hallmark Health Medical Associates Wellforce $28.6 M MetroWest Physicians Services Tenet Healthcare $6.7 M $215,000 to $1 billion. C Practice Associates Partners $35.9 M Berkshire Orthopaedic Associates Berkshire Health $7.4 M Only five of 50 physician The Affiliated Physicians roup Care roup $62.3 M Mount Auburn Professional Services Care roup $65.3 M organizations reported a profit, Southcoast Physician roup Southcoast Health $162.3 M New England Baptist Medical Associates Care roup $7.1 M which ranged from $1.4 million to Lahey Clinic Lahey Health $262.4 M Medical Affiliates of Cape Cod Cape Cod Healthcare $87.8 M $113 million. The losses ranged Heywood Medical roup Heywood Health $21.4 M from $261,000 to $77 million. Jordan Physician Associates Care roup $32.8 M Circle Health Physicians Wellforce $44.1 M ana-Farber Cancer Care Network ana-Farber $36.5 M The three physician organizations Boston University Affiliated Physicians BMC Health $2.2 M with the largest revenue, Riverbend Medical roup Trinity Health $71.5 M Sturdy Memorial Associates Sturdy Memorial Foundation $47.4 M Massachusetts General Hospital Baystate Medical Practice Baystate Health $170.9 M Milford Regional Phys. roup Milford Regional Medical Center $59.6 M Physicians Organization, Brigham Seacoast Affiliated roup Practice Seacoast Regional Health $15.8 M and Women’s Physicians Signature Healthcare Medical roup Signature Healthcare $59.8 M UMass Memorial Medical roup UMass Memorial Health Care $363.4 M Organization, and Physicians Winchester Physician Associates Lahey Health $33.7 M Partners Community Phys. Org. Partners $63.8 M Organization at Children’s Coastal Medical Associates South Shore Health $70.9 M North Shore Physicians roup Partners $117.6 M Hospital and Foundation, also BMC Faculty Practice Foundation BMC Health $170.6 M reported the largest total margins Tufts Medical Center Physician Organization Wellforce $146.8 M Newton-Wellesley Physician Hospital roup Partners $62.0 M at 4.5%, 3.7%, and 13.6%, New England Baptist Physician roup Care roup $0.2 M Massachusetts Eye and Ear Associates Partners $54.5 M respectively. Harvard Medical Faculty Physicians Care roup $347.7 M Brigham and Women s Physician Organization Partners $669.2 M Mass. eneral Hospital Physician Organization Partners $782.2 M Physician Organization at Children s Hospital Boston Children s Hosp. & Sub. $636.6 M - -120% -100% -80% -60% -40% -20% 0% 20% Notes: Steward Health Care’s physician level data are not included as they did not submit audited financial statements. Cambridge Health Alliance reports its physician organization as an integrated component of the acute hospital.
9 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA PROFITABILITY FY 2014-FY 2018 HHS-Afilliated Health Plan Total Margin
Three hospital health systems have an associated health 2% plan: Baystate Health, Boston 2% Medical Center and Affiliates, 0%0% and Partners Healthcare. In FY 2018, all three health plans -2%-2% reported a profit. However, only Neighborhood Health -4%-4% Plan (affiliated with Partners Healthcare) saw an increase in -6%-6% total margin between FY 2017 and FY 2018. -8%-8% The health plans’ financial performances have varied -10%-10% during the last five fiscal years. Neighborhood Health Plan -12%-12% reported a profit in fiscal years F 2014 F 2015 F 2016 F 2017 F 2018 2017 and 2018 after reporting losses in the three previous BMC Health Plan Health New England Neighborhood Health Plan years. Health New England reported a profit every year with the exception of FY 2015. 2014 2015 2016 2017 2018 BMC Health Plan reported BMC Health Plan profits in fiscal years 2015, 0.2% (Boston Medical Center and Affiliates) -2.7% 2.5% -0.4% 0.5% 2017, and 2018. Health New England 1.5% (Baystate Health) 1.1% -3.9% 1.6% 2.2% Neighborhood Health Plan 2.9% (Partners HealthCare) -12.1% -0.5% -4.5% 2.0%
10 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA LIQUIDITY FY 2018 Current Ratio for Systems with Multiple Acute Hospitals
Current ratio measures short- 8.0 8.0 term financial health and 7.5 7.5 indicates whether an entity is 7.0 7.0 able to meet current liabilities 6.5 6.5 with current assets. A ratio of 6.0 6.0 1.0 or higher means that current 5.5 5.5 liabilities could be adequately 5.0 5.0 covered by existing current 4.5 4.5 assets and indicates financial 4.0 4.0 stability. 3.5 3.5 Ten of the eleven hospital health 3.0 3.0 systems with multiple acute 2.5 2.5 hospitals reported a current ratio 2.0 2.0 at or above 1.0, indicating that 1.5 these systems can meet their 1.5 current liabilities with their current 1.0 1.0 assets. 0.5 0.5 0.0 0.0 Four of the 44 hospitals that are affiliated with multi-acute Wellforce
hospital health systems reported Care roup a current ratio below 1.0. The Baystate Health Tenet Healthcare Healthcare Tenet Partners HealthCare Partners HealthCare
current ratio measures ranged Lahey Health System Steward Health Care Steward Cape Cod Healthcare Heywood Healthcare Heywood Healthcare
from 0.4 (Baystate Noble Health Systems Berkshire
Hospital) to 6.4 (Steward Saint UMass Memorial Health Care Anne’s Hospital). Academic Community Community-High Health Specialty Teaching Medical Center Hospital Public Payer System Hospital Hospital
Notes: Shriners Hospitals for Children are not included in the analysis or graph due to reporting differences.
11 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA LIQUIDITY FY 2018 Current Ratio for Independent Health Systems
All of the independent hospital 8.0 health systems reported a 7.5 current ratio above 1.0 in 7.0 FY 2018, indicating that all 6.5 independent hospital health 6.0 systems can meet current liabilities with current assets. 5.5 All of the hospitals associated 5.0 with independent hospital 4.5 health systems reported a 4.0 current ratio above 1.0 in FY 3.5 2018. Current ratios for the 3.0 hospitals ranged from 1.2 at Signature Healthcare Brockton 2.5 Hospital to 7.6 at Boston 2.0
Children’s Hospital. 1.5
1.0
0.5
0.0 and Affiliates Trinity Health Trinity and Affiliates and Affiliates Health System Health System and Subsidiaries and Subsidiaries and Subsidiaries Seacoast Regional Valley Health System Valley Boston Medical Center Center and Subsidiaries Emerson Health System Milford Regional Medical Milford Cambridge Health Alliance Boston Children s Hospital Boston Children s Lawrence eneral Hospital Lawrence South Shore Health System South Shore Southcoast Health Systems Sturdy Memorial Foundation Sturdy ana-Farber Cancer nstitute Harrington Health Care System Harrington Health Care Signature Healthcare Corporation Healthcare Signature
Academic Community Community-High Health Specialty Teaching Medical Center Hospital Public Payer System Hospital Hospital
12 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA LIQUIDITY FY 2018 Average Payment Period by Health System
Average payment period Baystate Health 54 Multi-Acute Hospital Health System measures the time it takes Berkshire Health Systems 42 hospitals to pay current ndependent Hospital Health System Boston Children s Hospital and Subsidiaries 74 liabilities. Higher values may 10 ays indicate potential liquidity Boston Medical Center Health System 69 problems and an inability to pay Cambridge Health Alliance 57 current obligations. Cape Cod Healthcare 57 Among the 15 independent Care roup 47 health systems, Seacoast ana-Farber Cancer nstitute and Subsidiaries 59 Regional Health System reported the lowest average Emerson Health System and Subsidiaries 62 payment period with 35 days, Harrington HealthCare System 63 while Trinity Health reported the Heywood Healthcare 48 highest average payment period Lahey Health System 67 with 86 days. Lawrence eneral Hospital and Affiliates 63 Among the 11 multi-acute Milford Regional Medical Center and Affiliates 41 systems, Berkshire Health Systems reported the lowest Partners HealthCare 70 average payment period with Seacoast Regional Health System 35 42 days, while Tenet Healthcare Signature Healthcare Corporation 56 reported the highest average South Shore Health System 54 payment period with 82 days. Southcoast Health Systems 56 Steward Health Care 78 Sturdy Memorial Foundation and Affiliates 39 Tenet Healthcare 82 Trinity Health 86 UMass Memorial Health Care 68 Valley Health System 44 Wellforce 66
Notes: Shriners Hospitals for Children are not included in the analysis or graph due to reporting differences.
13 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA LIQUIDITY FY 2014-FY 2018 Current Ratio and Average Payment Period Trends
The statewide acute hospital Current Ratio Trends Average Payment Period Trends median current ratio has 2.1 remained relatively stable 110 over time. 2.0
The current ratio of the 100
Academic Medical Center, 1.9 community, and community- 90 High Public Payer cohorts 1.8 remained stable year over year, 80 while the teaching cohort saw 1.7 an increase of 0.4. 70 The statewide acute hospital 1.6 median for average payment 60 period decreased by eight days between 2017 and 2018. Most 1.5 50 hospital cohorts also saw a decrease in average payment 40 1.4 period. Only the Academic F 2014 F 2015 F 2016 F 2017 F 2018 F 2014 F 2015 F 2016 F 2017 F 2018 Medical Center cohort had an increase in average payment Statewide Acute Academic Medical Center Teaching Hospital Community Hospital Community-High Public Payer Hospital Health System period. The teaching hospital cohort had the largest decrease 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 in average payment period, Statewide Acute Median 1.6 1.6 1.7 1.6 1.6 Statewide Acute Median 60 60 56 57 49 decreasing by 23 days. Academic Medical Center 1.6 Academic Medical Center 62 The hospital health system 1.6 1.6 1.7 1.6 64 63 64 59 median current ratio and Teaching Hospital 1.4 1.6 1.7 1.6 2.0 Teaching Hospital 80 107 53 60 43 average payment period Community Hospital 1.8 2.0 2.0 1.7 1.7 Community Hospital 53 53 44 53 50 both increased between 2017 and 2018. The current Community-High Public Payer 1.6 1.5 1.6 1.4 1.4 Community-High Public Payer 66 68 59 57 47 ratio increased by 0.1 and the average payment period Health System 1.7 1.7 1.8 1.5 1.6 Health System 62 65 60 57 59 increased by two days. Notes: Steward Health Care’s system level data are not included in 2016-2017 as they did not submit audited or standardized financial statements. The statewide acute hospital median includes specialty hospitals.
14 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA SOLVENCY FY 2018 Equity Financing Ratio by Health System
The equity financing ratio 100% measures the proportion of total net assets financed with the 90% health system’s equity. It reflects a health system’s ability to take on 80% more debt. High values indicate health systems with little or no 70% long-term debt. Low values indicate health systems that are highly leveraged. 60% All but one of the health systems reported positive equity financing 50% ratios. For all of the health systems, Sturdy Memorial 40% Foundation and Affiliates reported the highest equity financing ratio 30% at 92.4%, while Steward Health Care reported the lowest ratio at 20% -37.6%. Among the 15 independent
10% health systems, Sturdy Memorial Foundation and Affiliates reported ≈ the highest equity financing ratio 0% at 92.4%, while Valley Health 0% System reported the lowest ratio at 7.7%. System Wellforce Berkshire Cape Cod Healthcare Care roup Among the 11 health systems Cambridge Health Care Corporation Southcoast and Affiliates Valley Health Valley Trinity Health Trinity South Shore South Shore Care Systems Care Health System Health System Health Alliance Health System Health Systems
with multiple acute hospitals, Baystate Health Health Systems and Subsidiaries Tenet Healthcare Tenet UMass Memorial Sturdy Memorial Sturdy and Subsidiaries Harrington Health Seacoast Regional Steward HealthCare Steward
Berkshire Health Systems Partners HealthCare ana-Farber Cancer Signature Healthcare Signature Lahey Health System Haywood HealthCare Boston Medical Center reported the highest equity Center and Subsidiaries Emerson Health System Milford Regional Medical Milford nstitute and Subsidiaries Foundation and Affiliates Foundation and Affiliates Boston Children s Hospital Boston Children s financing ratio at 71.5%, while eneral Hospital Lawrence Steward Health Care reported the ndependent Hospital Health System Multi-Acute Hospital Health System lowest ratio at -37.6%. Notes: Steward Health Care’s system level data is an outlier with an equity financing ratio below 0%. Shriners Hospitals for Children are not included in the analysis or graph due to reporting differences.
15 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA SOLVENCY FY 2014-FY 2018 Equity Financing Ratio Trends
The statewide acute hospital 60% median for equity financing increased by 0.9 percentage 55% points in 2018 compared to the prior year, indicating that overall 50% hospitals are less leveraged by debt than they were in the 45% previous year. 40% Equity financing varied among the hospital cohorts in 2018. 35% The teaching cohort had an increase in median equity 30% financing ratio between 2017 and 2018, while the Academic 25% Medical Center, community, and community-High Public Payer 20% cohorts decreased. F 2014 F 2015 F 2016 F 2017 F 2018
The Academic Medical Center Statewide Acute Academic Medical Center Teaching Hospital Community Hospital Community-High Public Payer Hospital Health System cohort had the lowest median equity financing ratio for 2014 2015 2016 2017 2018 the third consecutive year, indicating these hospitals are Statewide Acute Median 51.4% 47.4% 47.7% 53.1% 54.0% more leveraged by debt. Academic Medical Center 40.4% 37.2% 32.9% 39.8% 38.8% Teaching Hospital 23.2% 32.4% 36.5% 42.9% 46.7% Community Hospital 44.3% 45.6% 46.5% 49.3% 48.1% Community-High Public Payer 51.1% 46.5% 48.0% 52.8% 52.5%
Health System 51.4% 49.7% 45.1% 48.4% 47.9%
Notes: Steward Health Care’s system level data are not included in 2016-2017 as they did not submit audited or standardized financial statements. The statewide acute hospital median includes specialty hospitals.
16 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA PROFITABILITY FY 2018 Acute Hospital Total Margin by Region
The density of hospitals across the Massachusetts regions varies greatly; the Metro Boston region contains the most hospitals with Northeastern 19, while the Southcoast region Massachusetts encompasses the least amount of 1.9% hospitals with two. Western Central Massachusetts Massachusetts Metro The Western Massachusetts and 1.3% 3.4% Boston Northeastern Massachusetts 5.6% regions had the lowest median total margins at 1.3% and 1.9%, Metro West respectively. The Southcoast 3.9% region had the highest median Metro total margin at 10.7%. South 5.1% The Metro Boston region Median Total Margin contained the hospital with the Southcoast lowest total margin at -19.7% for 1.3% 10.7% 10.7% Steward Carney Hospital. The Acute Hospitals Total Margin Central Massachusetts region -5% -5% -3% -3% 0% 0% 3% 3% 5% 5% Cape and contained the hospital with the Islands highest total margin at 14.6% for 4.9% Saint Vincent Hospital.
17 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA FY 2018 Health System, Hospital, Physician Organization, and Health Plan Metrics
Excess Average (Deficit) of Months Current Payment Operating Total Revenue over Equity Entity Name Organization Type Reported Ratio Period Margin Margin Expenses Financing Net Assets Baystate Health 12 2.2 54 2.2% 2.8% $68.1 50.7% $1,101.8 Baystate Franklin Community-High Public Payer 12 1.7 38 0.4% 0.6% $0.6 57.4% $53.2 Baystate Medical Center ε Teaching Hospital 12 3.5 37 6.6% 7.6% $99.8 60.7% $827.7 Baystate Noble Community-High Public Payer 12 0.4 109 2.0% 2.0% $1.2 40.9% $16.8 Baystate Wing Community-High Public Payer 12 1.2 93 -5.7% -5.1% ($4.4) 47.9% $50.2 Baystate Medical Practices Physician Organization 12 -14.2% -14.2% ($43.6) Baystate Westfield Medical Corp. Physician Organization 12 -43.4% -43.4% ($5.4) Health New England Health Plan 12 1.6% 1.5% $12.3 Berkshire Health Systems 12 1.7 42 1.4% 4.7% $30.4 71.5% $483.0 Berkshire Medical Center Community-High Public Payer 12 1.4 55 5.7% 9.4% $49.4 72.6% $440.0 Fairview Hospital Community-High Public Payer 12 1.3 28 2.8% 6.4% $3.6 73.9% $36.7 Berkshire Faculty Services Physician Organization 12 -47.1% -47.1% ($19.8) Berkshire Orthopaedic Associates Physician Organization 12 -38.3% -38.3% ($2.9) Boston Children’s Hospital and Subsidiaries 12 1.5 74 2.3% 16.7% $500.0 73.4% $6,054.3 Boston Children’s Hospital Specialty Hospital 12 7.6 97 2.3% 6.7% $122.9 67.8% $4,047.8 Physicians Organization at Children’s Physician Organization 12 4.9% 13.6% $113.4 Hospital and Foundation Boston Medical Center Health System 12 1.5 69 0.0% 0.7% $25.7 52.4% $1,633.2 Boston Medical Center ε Academic Medical Center 12 1.7 100 2.6% 3.3% $49.4 54.2% $1,344.1 Boston University Affiliated Physicians Physician Organization 12 -15.4% -15.4% ($0.8) BMC Faculty Practice Foundation Physician Organization 12 -0.9% -1.6% ($5.8) BMC Health Plan (BMCHP) Health Plan 12 -0.5% 0.2% $3.1 Cambridge Health Alliance 12 3.6 57 -0.5% 1.6% $10.4 43.1% $241.8 Cambridge Health Alliance ε Teaching Hospital 12 2.1 49 -0.5% 1.1% $7.5 7.2% $24.8 Cape Cod Healthcare 12 1.7 57 2.2% 7.2% $71.0 69.4% $788.1 Cape Cod Hospital Community-High Public Payer 12 2.2 40 6.9% 8.3% $48.1 70.9% $450.1 Falmouth Hospital Community-High Public Payer 12 1.4 40 3.9% 6.6% $11.1 82.8% $232.4 Medical Affiliates of Cape Cod, Inc Physician Organization 12 -25.2% -25.2% ($22.5)
18 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Excess Average (Deficit) of Months Current Payment Operating Total Revenue over Equity Entity Name Organization Type Reported Ratio Period Margin Margin Expenses Financing Net Assets CareGroup 12 3.2 47 0.6% 3.1% $110.1 53.4% $2,021.1 Beth Israel Deaconess Hospital - Milton Community Hospital 12 2.3 62 3.8% 4.7% $5.8 56.4% $91.3 Beth Israel Deaconess Hospital - Needham Community Hospital 12 1.7 67 5.3% 5.6% $5.4 34.8% $54.2 Beth Israel Deaconess Hospital - Plymouth Community-High Public Payer 12 2.1 45 4.0% 5.1% $14.2 48.7% $101.0 Beth Israel Deaconess Medical Center Academic Medical Center 12 3.0 53 2.7% 5.6% $103.9 50.2% $1,105.7 Mt. Auburn Hospital Teaching Hospital 12 3.3 55 3.5% 6.0% $21.0 56.7% $251.8 New England Baptist Hospital Specialty Hospital 12 4.8 33 1.9% 3.6% $8.9 62.6% $148.3 The Affiliated Physicians Group Physician Organization 12 -32.9% -32.9% ($26.8) Community Physicians Associates Physician Organization 12 -59.0% -59.0% ($2.3) Harvard Medical Faculty Physicians Physician Organization 12 2.3% 3.6% $22.8 Jordan Physicians Associates, Inc. Physician Organization 12 -20.3% -20.3% ($7.3) Mount Auburn Professional Services Physician Organization 12 -32.5% -32.5% ($24.7) New England Baptist Medical Associates Physician Organization 12 -29.5% -29.5% ($3.7) New England Baptist Physicians Group Physician Organization 12 0.0% 0.0% $0.0 Dana-Farber Cancer Institute and Subsidiaries 12 1.5 59 -3.2% 5.8% $106.7 60.3% $1,725.5 Dana-Farber Cancer Institute Specialty Hospital 12 1.6 61 -2.9% 6.3% $113.1 60.7% $1,754.9 Dana-Farber Cancer Care Network Physician Organization 12 -17.4% -17.4% ($6.4) Emerson Health System Inc. and Subsidiaries 12 1.6 62 2.0% 2.5% $6.3 29.3% $57.7 Emerson Hospital Community Hospital 12 1.6 62 2.0% 2.5% $6.2 29.5% $58.2 Harrington HealthCare System 12 2.6 63 -2.7% 0.0% $0.0 53.7% $76.9 Harrington Hospital Community-High Public Payer 12 2.8 72 5.0% 8.2% $12.1 54.7% $75.3 Harrington Physician Services Physician Organization 12 -48.9% -48.9% ($12.1) Heywood Healthcare 12 1.0 48 -1.9% -0.9% ($1.5) 46.6% $68.6 Athol Hospital Community-High Public Payer 12 0.9 65 4.4% 4.5% $1.2 34.4% $8.2 Heywood Hospital Community-High Public Paye 12 1.0 50 0.9% 2.3% $2.9 56.6% $53.0 Heywood Medical Group Physician Organization 12 -23.9% -23.9% ($5.5)
19 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Excess Average (Deficit) of Months Current Payment Operating Total Revenue over Equity Entity Name Organization Type Reported Ratio Period Margin Margin Expenses Financing Net Assets Lahey Health System 12 1.1 67 -1.4% -0.6% ($13.2) 46.1% $1,118.1 Lahey Hospital and Medical Center Teaching Hospital 12 0.7 83 6.4% 6.6% $66.4 -2.9% ($6.5) Northeast Hospital Community-High Public Payer 12 2.0 53 5.7% 7.4% $28.0 53.8% $234.5 Winchester Hospital Community Hospital 12 1.4 62 -2.3% -0.3% ($0.9) 65.4% $294.3 Lahey Clinic Physician Organization 12 -24.5% -26.9% ($77.2) Lahey Physician Community Org Physician Organization 12 -55.0% -55.3% ($8.3) Northeast Medical Practice Physician Organization 12 -52.9% -52.1% ($14.1) Winchester Physician Association Physician Organization 12 -9.3% -9.3% ($3.6) Lawrence General Hospital and Affiliates 12 2.1 63 -1.8% -1.8% ($4.8) 38.9% $111.9 Lawrence General Hospital Community-High Public Payer 12 1.7 66 0.4% -0.1% ($0.2) 46.3% $115.4 Community Medical Associates. Physician Organization 12 -71.9% -72.0% ($2.8) Milford Regional Medical Center and Affiliates 12 2.7 41 -0.9% -0.1% ($0.4) 46.3% $122.8 Milford Regional Medical Center Community Hospital 12 3.2 41 2.9% 3.9% $8.5 48.1% $122.0 Milford Regional Physician Group Physician Organization 12 -13.6% -13.6% ($8.9) Partners HealthCare 12 2.3 70 2.2% 6.0% $826.6 49.0% $8,972.6 Brigham & Women’s Faulkner Hospital Community Hospital 12 1.4 47 10.8% 10.9% $30.2 67.9% $103.4 Brigham & Women’s Hospital Academic Medical Center 12 1.3 70 5.6% 5.6% $173.0 27.4% $833.2 Cooley Dickinson Hospital Community Hospital 12 0.6 66 -1.8% -0.3% ($0.6) 17.7% $23.7 Martha’s Vineyard Hospital Community Hospital 12 2.1 44 0.2% 3.2% $2.9 79.4% $120.1 Massachusetts Eye & Ear Infirmary Specialty Hospital 12 1.5 142 2.7% 9.9% $15.9 58.1% $318.1 Massachusetts General Hospital Academic Medical Center 12 1.7 42 6.2% 6.2% $250.6 63.0% $2,488.4 Nantucket Cottage Hospital Community Hospital 12 4.8 34 -18.3% -10.8% ($5.8) 94.1% $142.3 Newton-Wellesley Hospital Community Hospital 12 1.7 43 2.7% 0.2% $1.0 48.1% $203.1 North Shore Medical Center Community-High Public Payer 12 2.8 87 -7.7% -7.6% ($32.2) -13.7% ($91.0) Brigham and Women’s Physicians Organization Physician Organization 12 1.7% 3.7% $32.7 CD Practice Associates Physician Organization 12 -39.4% -39.4% ($14.4) Massachusetts Eye and Ear Associates Physician Organization 12 2.0% 2.1% $1.4 Massachusetts General Hospital Physicians Organization Physician Organization 12 2.2% 4.5% $50.5 Nantucket Physician Organization Physician Organization 12 -85.3% -85.3% ($2.4) Newton-Wellesley Physician Hospital Group Physician Organization 12 0.0% -0.3% ($0.3) North Shore Physicians Group Physician Organization 12 -3.5% -3.5% ($5.3) Partners Community Physician Organization Physician Organization 12 -8.8% -6.3% ($6.6) Neighborhood Health Plan Health Plan 12 2.6% 2.9% $41.8
20 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Excess Average (Deficit) of Months Current Payment Operating Total Revenue over Equity Entity Name Organization Type Reported Ratio Period Margin Margin Expenses Financing Net Assets Seacoast Regional Health System 12 2.2 35 0.0% 0.4% $0.7 47.9% $52.3 Anna Jaques Hospital Community Hospital 12 2.1 36 1.0% 1.3% $1.8 38.1% $33.5 Seacoast Affiliated Group Practice Physician Organization 12 -13.4% -13.4% ($2.2) Shriners Hospitals for Children 12 0.8 194 -95.0% -95.0% ($775.6) 91.1% $8,717.7 Shriners Hospital for Children - Boston* Specialty Hospital Shriners Hospital for Children - Springfield* Specialty Hospital Signature Healthcare Corporation 12 1.1 56 0.8% 3.1% $11.5 37.2% $102.7 Signature Healthcare Brockton Hospital Community-High Public Payer 12 1.2 63 3.6% 6.7% $19.9 36.3% $88.8 Signature Healthcare Medical Group Physician Organization 12 -11.0% -11.0% ($8.5) South Shore Health System 12 1.9 54 -0.8% -0.3% ($2.4) 46.6% $381.2 South Shore Hospital Community Hospital 12 1.5 53 1.5% 1.7% $10.7 45.7% $304.6 Coastal Medical Associates Physician Organization 12 -3.6% -3.6% ($2.8) Southcoast Health Systems 12 1.3 56 0.0% 2.7% $28.6 62.3% $751.8 Southcoast Hospital Group Community-High Public Payer 12 1.4 60 5.9% 8.4% $71.8 58.1% $556.4 Southcoast Physician Group Physician Organization 12 -29.8% -29.8% ($59.2) Steward Health Care 12 0.8 78 -4.2% -4.1% ($271.1) -37.6% ($1,209.6) Morton Hospital Community-High Public Payer 12 1.2 33 -7.5% -7.2% ($8.6) 50.9% $16.6 Nashoba Valley Medical Center Community-High Public Payer 12 1.7 28 -3.4% -1.9% ($1.1) 18.8% $2.2 Steward Carney Hospital ε Teaching Hospital 12 1.3 37 -21.6% -19.7% ($23.3) 29.6% $11.3 Steward Good Samaritan Medical Center Community-High Public Payer 12 3.7 37 12.5% 12.7% $38.1 71.6% $86.7 Steward Holy Family Hospital Community-High Public Payer 12 1.0 34 5.7% 6.5% $16.3 16.1% $5.8 Steward Norwood Hospital Community-High Public Payer 12 1.2 36 4.9% 5.7% $11.2 41.1% $17.1 Steward Saint Anne’s Hospital Community-High Public Payer 12 6.4 32 12.6% 12.9% $35.6 84.4% $142.0 Steward St. Elizabeth’s Medical Center ε Teaching Hospital 12 1.1 43 4.8% 5.0% $19.2 46.7% $44.7 Steward Medical Group v Physician Organization Sturdy Memorial Foundation and Affiliates 12 2.2 39 2.0% 7.2% $18.2 92.4% $487.4 Sturdy Memorial Hospital Community-High Public Payer 12 2.3 40 5.7% 11.5% $23.3 92.9% $434.7 Sturdy Memorial Associates Physician Organization 12 -14.5% -14.6% ($7.6) Tenet Healthcare 12 1.2 82 1.7% 0.6% $111.0 9.4% $2,107.0 MetroWest Medical Center Community-High Public Payer 12 1.5 47 1.7% 1.9% $4.8 42.2% $48.1 Saint Vincent Hospital ε Teaching Hospital 12 2.0 36 14.6% 14.6% $72.2 128.8% $487.6 Metrowest Physician Services Physician Organization 12 -41.4% -41.4% ($4.5) Saint Vincent Medical Company Physician Organization 12 -42.9% -42.9% ($14.8)
21 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Excess Average (Deficit) of Months Current Payment Operating Total Revenue over Equity Entity Name Organization Type Reported Ratio Period Margin Margin Expenses Financing Net Assets Trinity Health 12 1.9 86 0.7% 4.7% $901.5 50.9% $13,344.0 Mercy Medical Center Community-High Public Payer 12 4.1 41 -4.2% -4.2% ($12.6) 54.5% $155.6 Mercy Inpatient Medical Associates Physician Organization 12 -115.9% -115.9% ($11.3) Mercy Medical Group Physician Organization 12 -54.7% -54.7% ($6.4) Mercy Specialist Physicians Physician Organization 12 -48.1% -48.1% ($3.0) Pioneer Valley Cardiology Associates Physician Organization 12 -66.9% -66.9% ($5.4) Riverbend Medical Group Physician Organization 12 -15.1% -15.1% ($14.5) UMass Memorial Health Care 12 1.4 68 -2.8% -0.8% ($19.3) 41.0% $1,015.7 HealthAlliance - Clinton Hospital Community-High Public Payer 12 1.1 121 -8.2% -6.7% ($13.7) 59.6% $166.1 Marlborough Hospital Community-High Public Payer 12 2.5 44 -3.0% -0.2% ($0.1) 63.3% $48.6 UMass Memorial Medical Center ε Academic Medical Center 12 1.2 74 -0.4% 0.1% $1.7 14.7% $177.3 UMass Memorial Medical Group Physician Organization 12 -10.1% -9.8% ($52.4) Valley Health System 12 1.5 44 0.7% 1.0% $1.9 7.7% $9.0 Holyoke Medical Center Community-High Public Payer 12 1.4 46 3.0% 3.2% $5.4 -1.0% ($0.9) Western Mass Physician Associates Physician Organization 12 -47.8% -47.8% ($4.1) Wellforce 12 1.3 66 0.2% 2.0% $38.5 34.0% $620.5 Lowell General Hospital Community-High Public Payer 12 1.2 93 3.2% 4.8% $23.2 32.9% $161.0 MelroseWakefield Health Community-High Public Payer 12 1.4 86 4.7% 7.9% $20.1 51.1% $150.3 Tufts Medical Center ε Academic Medical Center 12 1.4 47 2.9% 4.4% $39.3 21.2% $155.4 Circle Health Physicians Physician Organization 12 -20.2% -20.2% ($8.9) Hallmark Health Medical Associates Physician Organization 12 -42.8% -42.8% ($14.3) Tufts Medical Center Community Care Physician Organization 12 -72.8% -72.8% ($3.9) Tufts Medical Center Physician Organization Physician Organization 12 -1.5% -1.5% ($3.8)
All dollar values are in millions. ε Hospital meets the High Public Payer threshold. ν Steward Health Care’s physician organization data is not included as they did not submit audited financial statements. * Shriners Hospital Boston (SHB) and Shriners Hospital Springfield (SHS) are part of the national Shriners Hospitals for Children system (SHC) and are reliant upon support from the SHC endowment to cover the costs associated with fulfilling their mission to provide care to patients regardless of /their ability to pay. This support is provided through transfers from the SHC’s endowment to the hospitals, as these transfers are not considered revenue for the purpose of calculating profitability margin, SHB’s and SHS’s profitability margins are not comparable to other acute hospitals. Therefore, they have been excluded from the graphics but are included in the statewide median and the databook.
22 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Report Notes
Acute Hospital and Health System Fiscal Year-End Dates The Fiscal Year 2018 analysis is based on 12 months of financial data for all entities. The majority of health systems and hospitals have a fiscal year end date of September 30; however, Cambridge Health Alliance and Mercy Medical Center have a June 30 year end date, and MetroWest Medical Center, Saint Vincent Hospital, Shriners - Boston, Shriners - Springfield and Steward Health Care System’s eight hospitals have a December 31 year end date.
Hospitals Fiscal Year End FY 2018 Data Period
Majority of Hospitals (49) 9/30 10/1/17 – 9/30/18
Cambridge Health Alliance 6/30 7/1/17-6/30/18 Mercy Medical Center
MetroWest Medical Center Saint Vincent Hospital Shriners Hospitals for Children Boston 12/31 1/1/18-12/31/18 Shriners Hospitals for Children Springfield Steward Health Care System Hospitals (8)
Data Caveats Wellforce (parent health system of Lowell General Hospital, MelroseWakefield Health, and Tufts Medical Center) became financially consolidated in FY 2018. This is the first annual report in which they are reported as a single health system and as a multi-acute health system. Steward Health Care system level data included in this report was derived from publicly available audited financial statements that were standardized by CHIA using the same method as the other health systems.
23 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Acute Hospital Cohort Definitions Acute hospitals were assigned to one of the following cohorts according to the criteria below. Please note that some AMCs and teaching hospitals have High Public Payer (HPP) status; this has been noted throughout the report where applicable. For this report, FY 2018 data is used to determine cohorts.
Academic Medical Centers (AMC) are a subset of teaching hospitals. AMCs are characterized by (1) extensive research and teaching programs, and (2) extensive resources for tertiary and quaternary care, and are (3) principal teaching hospitals for their respective medical schools, and (4) full service hospitals with case mix intensity greater than 5% above the statewide average.
Teaching hospitals are those hospitals that report at least 25 full-time equivalent medical school residents per 100 inpatient beds in accordance with Medicare Payment Advisory Commission and which do not meet the criteria to be classified as AMCs.
Community hospitals are hospitals that do not meet the 25 full-time equivalents medical school residents per 100 beds criteria to be classified as a teaching hospital and have a public payer mix of less than 63%.
Community-High Public Payer (HPP) are community hospitals that are disproportionately reliant upon public revenues by virtue of a public payer mix of 63% or greater. Public payers including the Health Safety Net.
Specialty hospitals are not included in any cohort comparison analysis due the unique patient populations they serve and/or the unique sets of services they provide. However, specialty hospitals are included in all statewide median calculations.
24 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Regional Definitions The geographic regions presented in this report are derived from the Health Policy Commission (HPC) static geographic regions. The HPC regions1 were rolled up into larger regions to facilitate better comparison within each geographic area. For additional information please refer to http://chiamass.gov/hospitals-by-region/.
Massachusetts Region Acute Hospital Assigned to Region Metro Boston
Beth Israel Deaconess Hospital – Milton Beth Israel Deaconess Hospital – Needham Beth Israel Deaconess Medical Center Boston Children’s Hospital Boston Medical Center Brigham and Women’s Faulkner Hospital Brigham and Women’s Hospital Cambridge Health Alliance Dana-Farber Cancer Institute Massachusetts Eye and Ear Infirmary Massachusetts General Hospital Hallmark Health Mount Auburn Hospital New England Baptist Hospital Newton-Wellesley Hospital Shriners Hospitals for Children- Boston Steward Carney Hospital Steward St. Elizabeth’s Medical Center Tufts Medical Center
1 For descriptions of the regions, see https://www.mass.gov/files/documents/2016/07/uc/2013-cost-trends-report-technical-appendix-b3-regions-of- massachusetts.pdf (last accessed September 24, 2019).
25 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Massachusetts Region Acute Hospital Assigned to Region Northeastern Massachusetts
Anna Jaques Hospital Emerson Hospital Lahey Hospital & Medical Center Lawrence General Hospital Lowell General Hospital Nashoba Valley Medical Center North Shore Medical Center Northeast Hospital Steward Holy Family Hospital Winchester Hospital Central Massachusetts
Athol Hospital Clinton Hospital Harrington Memorial Hospital HealthAlliance Hospital Heywood Hospital Saint Vincent Hospital UMass Memorial Medical Center Cape and Islands
Cape Cod Hospital Falmouth Hospital Martha’s Vineyard Hospital Nantucket Cottage Hospital Metro West
Marlborough Hospital MetroWest Medical Center Milford Regional Medical Center Steward Norwood Hospital Sturdy Memorial Hospital
26 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA Massachusetts Region Acute Hospital Assigned to Region Western Massachusetts
Baystate Franklin Medical Center Baystate Medical Center Baystate Noble Hospital Baystate Wing Hospital Berkshire Medical Center Cooley Dickinson Hospital Fairview Hospital Holyoke Medical Center Mercy Medical Center Shriners Hospitals for Children - Springfield Metro South
Beth Israel Deaconess Hospital – Plymouth Morton Hospital Signature Healthcare Brockton Hospital South Shore Hospital Steward Good Samaritan Medical Center Southcoast
Steward Saint Anne’s Hospital Southcoast Hospitals Group
Individual hospital trend analysis (fact sheets) and the databook are available on CHIA’s website at http://www.chiamass.gov/hospital-financial-performance/.
27 Massachusetts Acute Hospital and Health System Financial Performance: FY 2018 | September 2019 center for health information and analysis CHIA For more information, please contact: CHIA CENTER FOR HEALTH INFORMATION AND ANALYSIS
501 Boylston Street www.chiamass.gov Boston, MA 02116 @Mass_CHIA (617) 701-8100
Publication Number 19-270-CHIA-01